HSJ’s expert briefing on NHS finances, savings and efforts to get the health service back in the black. This week by correspondent Nick Carding.

Following the postponement of the comprehensive spending review, 2019 was not looking like a great year for NHS staff hungry for news on capital funding.

That changed when new prime minister Boris Johnson promised “20 hospital upgrades” in his first speech since taking office three weeks ago.

Last week, we found out which were the lucky 20 trusts

Joy for Cornwall

The biggest project (in terms of estimated cost) was the only one which made it into HSJ’s list of 20 major capital projects local leaders want to deliver.

This was the £99.5m women and children’s facility at Royal Cornwall Hospitals Trust, for which the trust submitted an unsuccessful bid in July 2018 as part of the sustainability and transformation partnership bid process (which ran between 2017 and 2018).

The news marked a successful year for the trust, which also had two capital bids worth £40m in total approved by the centre through the STP bid process.  

RCHT was one of just two NHS organisations (the other was Isle of Wight Trust) across the southern NHS patch to be awarded money, with much of the new funding concentrated in the Midlands and northern regions. 

Ignored STPs receive green light

Some critics said this amounted to the new prime minister prioritising areas which had voted to leave the European Union in the 2016 referendum.

This column will not speculate on that, but it’s worth pointing out trusts in the North and Midlands together submitted 222 bids for funding in the aforementioned STP process between 2017 and 2018, which dwarfed the number of bids submitted by trusts in the South East and South West (105).

Of the 20 schemes that were chosen for Mr Johnson’s announcement, at least half had funding turned down by the centre in the STP process.

It is not immediately possible to tell if the remaining schemes had been submitted through the STP process, due to differences in the descriptions and some trusts refusing to reveal their bids to HSJ.

Interestingly, four STPs (Birmingham and Solihull, Lincolnshire, East London, and Norfolk and Waveney) which received almost nothing during 2017 and 2018 were all rewarded this time with schemes allocated funding.

In Norfolk and Waveney’s case, the funding was very significant, with three schemes worth a combined £134.9m given the green light.

Yet there was still no money available for organisations within Northamptonshire STP, which remains the only health economy not to have received any funding from the STP process or Mr Johnson’s recent announcement. 

Unpicking the cash lock

Meanwhile, NHS organisations continue to work towards unlocking the allocations promised by the government in the last couple of years.

As HSJ revealed last month, only a fraction of promised funding has actually made it to the front-line so far.

Jonathan Stewart, chair of the Health Estates and Facilities Management Association, told HSJ it is common for trusts to spend up to at least six months just preparing and finalising their business case.

This often involves hiring architects, consultants, and design teams to help prepare the documents.

The process then requires the business case to be approved by various national bodies and sometimes tweaked or amended by the applicant.

The convoluted process is set for a change, however, with the NHS long-term plan committing national chiefs to devising a faster and more efficient way to help local organisations get the money promised earlier.

For many NHS estates chiefs, the sooner that happens the better.   

The HSJ Strategic Estates Forum, now in its 3rd year, takes place in London on 12 March 2020. This is a high level strategic forum that brings together estates directors, sustainability and transformation partnership estates leads and trust board leaders responsible for the estates function who are developing strategic plans for their organisations and local health economies. The focus of the forum is on issues such as availability of and access to capital, tackling backlog maintenance, utilisation of the estate and role of technology in infrastructure development. The forum builds on the Naylor Report and highly anticipated 2019 Spending Review. Register your place at this free to attend event on our website: https://strategicestates.hsj.co.uk/register-your-interest-2020